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Case Reports: Unusual presentation of more common disease/injury
Temporal arteritis presenting with facial swelling and a negative temporal artery biopsy
  1. Natalie Si-Yi Lee1,2,
  2. Tim Y Lu3,4,
  3. Alexandra Allende5 and
  4. Ian C Francis1,6,7
  1. 1Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  3. 3Faculty of Medicine, Macquarie University, Sydney, New South Wales, Australia
  4. 4Department of Rheumatology, Northern Beaches Hospital, Sydney, New South Wales, Australia
  5. 5Department of Pathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
  6. 6Department of Ophthalmology, Northern Beaches Hospital, Sydney, New South Wales, Australia
  7. 7Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Ian C Francis; iancfrancis{at}gmail.com

Abstract

A man in his 60s presented to the emergency department with marked bilateral preauricular swelling, associated with jaw claudication, temporal tenderness and blurred vision. He was immediately treated for temporal arteritis by commencing systemic corticosteroids. A temporal artery biopsy showed no evidence of vasculitis. However, positron emission tomography-CT demonstrated increased uptake in the medium-large vessels, including the left superficial temporal artery and aorta. This case illustrates that facial swelling may be an under-recognised presenting feature of temporal arteritis, and that a negative temporal artery biopsy does not always rule out a diagnosis of temporal arteritis, and should not delay treatment.

  • Vasculitis
  • Ophthalmology
  • Pathology

http://dx.doi.org/10.1136/bcr-2023-255731

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: NS-YL, TL, AA and ICF. The following authors gave final approval of the manuscript: NS-YL, TL, AA and ICF.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.